Chemotherapy begins soon after you are admitted to the hospital, after stem cell collection. Your doctor will discuss all of the drugs you will receive and their side effects. Your nurse practitioner, inpatient nurse and pharmacist also will be available to answer questions. In addition, you may receive written information on these drugs in a consent form.
Some precautions are taken to minimize side effects from these drugs. For example, when receiving some types of chemotherapy, patients must shower thoroughly twice a day to remove the drug that is excreted through the skin — this is done to help prevent or minimize chemotherapy burns. The inpatient nurse will go over any special precautions that you may need to take. Your doctor may also discuss medication (palifermin) to prevent some transplant-related complications prior to admission.
Some patients receive total body irradiation (TBI) in addition to chemotherapy. This radiation therapy is intended to destroy remaining cancer cells and further suppress the immune system.
TBI treatments are given in the radiotherapy department, usually over a period of three to four days. The treatment itself is painless, but there may be uncomfortable side effects after treatment, such as mouth and throat sores, nausea, stomach and intestinal irritations, and skin redness. Anti-nausea medication is usually given before each treatment to reduce nausea. You may receive additional medication (palifermin) to prevent mouth sores.
The transplant will occur one to three days after your last chemotherapy dose or anytime after your last radiation dose. The day of transplantation is referred to as Day 0. The days before the transplant are counted as minus days and the days after the transplant are plus days.
The procedure is similar to a simple blood transfusion and will be done in your hospital room. You may have a family member in the room with you if you wish. The actual procedure will take about 45 minutes, depending on the volume of stem cells. If you are receiving bone marrow, the infusion may take several hours. The blood stem cells will be infused through your central venous catheter.
Your nurse will check your blood pressure, temperature, breathing and pulse, and will watch for any side effects. Usually there are no side effects, but occasionally patients may experience a funny taste in the mouth, chills, flushing of the face, nausea and vomiting, headache, and changes in blood pressure and breathing.
The new bone marrow does not recover immediately after it has been transplanted. The stem cells of the transplanted marrow will travel to the bones, reseed the marrow space and go through a growth process before the mature cells are released from the bone marrow into the blood stream. It will take eight to 14 days from the day of transplantation for your marrow to start producing white blood cells, red blood cells and platelets.
Engraftment is the term used to describe when your new marrow begins to function and produce cells. While awaiting engraftment, no mature cells leave the marrow and enter the blood stream. Your blood counts will show very low values and you will require careful monitoring by the health care team. The goal is to support you with red blood cell and platelet transfusion until you are producing cells again.
Reviewed by health care specialists at UCSF Medical Center.